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BJA Advance Access published online on February 25, 2009
British Journal of Anaesthesia, doi:10.1093/bja/aep018
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2009. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Effects of phenylephrine on the sublingual microcirculation during cardiopulmonary bypass

S. Maier1, W. R. Hasibeder4, C. Hengl1, W. Pajk1, B. Schwarz1, J. Margreiter1, H. Ulmer2, J. Engl3 and H. Knotzer1,*

1 Department of Anaesthesiology and Critical Care Medicine
2 Department for Medical Statistics, Informatics and Health Economics and
3 Department of Cardiac Surgery and Cardiovascular Perfusion, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria
4 Department of Anaesthesiology and Critical Care Medicine, Krankenhaus der Barmherzigen Schwestern Ried, Schlossberg 1, A-4910 Ried i. I., Austria

* Corresponding author. E-mail: johann.knotzer{at}uki.at

Background: The objective of the present study was to investigate sublingual microvascular blood flow and microcirculatory haemoglobin oxygen saturation (SmcO2) during cardiopulmonary bypass (CPB) using constant systemic blood flow but different perfusion pressures achieved by phenylephrine administration.

Methods: Fifteen patients undergoing coronary artery bypass grafting were enrolled in this pilot study. Systemic haemodynamics, oxygen transport variables, arterial and mixed venous blood gas analysis, and microcirculatory variables were determined after initiation of general anaesthesia, during CPB (systemic blood flow=2.4 litre m–2), after increasing perfusion pressure by 20 mm Hg with a continuous infusion of phenylephrine, and after termination of phenylephrine infusion.

Results: CPB immediately resulted in a significant (P<0.05) decrease in systemic oxygen transport without alterations in sublingual microcirculatory blood flow and SmcO2. Increasing perfusion pressure from 47 (SD 9) to 68 (7) mm Hg using phenylephrine=1.4 (1.0) µg kg–1 min–1 resulted in a significant decrease in sublingual small vessel blood flow (from median 2.5 to 1.8 arbitrary units) representing mostly capillary blood flow, but not in medium-sized vessels (median 3 to 2.8 arbitrary units). Concurrently, global tissue blood flow from 110 (54) to 197 (100) perfusion units and SmcO2 increased from 72 (11)% to 84 (7)%, suggesting significant microcirculatory blood flow shunting in vessels with diameters >25 µm.

Conclusions: Our data demonstrate that an increased perfusion pressure produced by phenylephrine at constant CPB flow may decrease microcirculatory blood flow in the sublingual mucosal microcirculation due to microvascular blood flow shunting.

Keywords: blood flow; heart, cardiopulmonary bypass; microcirculation; oxygen, tissue; oxygen, uptake; surgery, cardiovascular


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Microvascular Accuracy
Paul WG Elbers, et al.
British Journal of Anaesthesia, 12 Mar 2009 [Full text]
Re: Microvascular Accuracy
Hans Knotzer, et al.
British Journal of Anaesthesia, 1 Apr 2009 [Full text]

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